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This newsletter is for everyone working with children and adults in Waltham Forest.
Please share with your colleagues and encourage them to sign up to get it regularly.
This Spotlight focuses on the dangers posed to our community by substance abuse, which is a safeguarding priority for the Strategic Partnerships.
Synthetic opioids are manmade drugs that mimic the effects of natural opioids, such as heroin, but often have a higher potency or toxicity. Synthetic opioids such as fentanyls and nitazenes caused spikes in drug-related deaths in England in 2017, 2021 and most recently in 2023. There are signs that synthetic opioids (and nitazenes in particular) are being seen more often in the UK drug market and there are concerns that they may become much more prevalent.
In light of this and international experience with fentanyls in North America, local Councils and their partners are preparing for potent opioids appearing in their area.
Potent synthetic opioids can be mixed with street heroin and are also sometimes seen in fake opioid tablets (like oxycodone blue or yellow tablets) and even occasionally in non-opioid drugs, like cocaine, benzodiazepines and synthetic cannabinoids (SCRAs). People who use drugs could be unknowingly or knowingly coming into contact with synthetic opioids.
Technically known as 2-benzyl benzimidazole opioids, nitazenes is a diverse group of synthetic opioids. Examples seen in this country include isotonitazene and metonitazene.
Many are far more toxic on a weight-for-weight basis than heroin. Even a small amount can be enough to kill, especially without immediate naloxone or medical attention.
Those in contact with people who use drugs should be alert to the increased possibility of overdose arising from ‘heroin’ or other drugs containing synthetic opioids, be able to recognise possible symptoms of overdose and respond appropriately.
The symptoms of an opioid overdose may include:
- Pinpoint pupils
- Drowsiness and/or dizziness
- Limp body
- Reduced or loss of consciousness
- Difficulties breathing
- Nausea and vomiting
- Cold and clammy skin
- Blue-coloured lips and fingernails
- Low blood pressure or decreased heart rate
What can reverse an overdose brought on by synthetic opioids?
There is good evidence that naloxone, the ‘antidote’ to opioid overdoses, works in these instances. The treatment required for an overdose that may be related to potent synthetic opioids is the same as for other opioid overdoses, but delivering it rapidly and completely is even more critical, as progression to respiratory arrest and recurrence of respiratory arrest, are more likely.
Anyone in the community can request free injectable naloxone and training on how to use it from CGL. Contact Hannah Myers-Smith, Senior Harm Reduction Lead at CGL, to arrange by emailing Hannah.MyersSmith@cgl.org.uk or calling 07586713420.
All organisations where staff may encounter people who use drugs should ensure those staff are:
- made aware of the risk of severe toxicity resulting from adulteration of heroin with potent synthetic opioids
- able to rapidly assess suspected opioid overdose
- made aware that the potency and toxicity of nitazenes is perhaps similar to, or more than, fentanyl, which is about 100x morphine
- alert to the symptoms of opioid overdose in known and suspected heroin users
- communicate these risks and harm reduction messages to heroin users during any contacts
- ensure people who use heroin and others who might encounter an opioid overdose have naloxone available
- able to provide or administer naloxone if appropriate
All organisations that provide emergency care for opioid overdose should ensure staff are supported to:
- treat suspected cases as for any opioid overdose, using naloxone and appropriate supportive care
- recognise the duration of action of naloxone is shorter than that of many opioids and appropriate monitoring and further doses of naloxone may be required. In the community this could include injectable or intranasal naloxone, administering a single dose and waiting for no response before administering more
Being in treatment greatly reduces the risk of harm and overdose. You can discuss treatment with CGL on 0203 826 9600. However, if you do choose to use, then:
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Go slow and be extra careful about your supply
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Do not use alone and ensure that only one person tests a small amount of the drug first
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Make sure you have enough naloxone – more doses may be required to reverse a synthetic opiate overdose
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Look after your friends and be aware of the signs of overdose and ready to use naloxone
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Do not mix drugs, including alcohol and other depressants such as diazepam and pregabalin
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Get rid of drugs safely, for example at a pharmacy or amnesty bin
Further advice and reporting:
To report any additional intelligence about the use of and harm from synthetic opioids, please email katla.arnarsdottir@walthamforest.gov.uk. This will enable suitable information to be shared with relevant agencies, and help in assessment of the need for any further action.
Up to date information for people considering using drugs, including advice on reducing risk, is available from www.talktofrank.com or from the FRANK helpline on 0800 77 66 00.
Information for clinicians on the clinical management of synthetic opioids was produced by the Novel Psychoactive Treatment UK Network (NEPTUNE) in 2018
Advice on responding in the community to an opioid overdose with naloxone is available from http://www.prenoxadinjection.com/ (for injectable Prenoxad®), https://www.nyxoid.com/uk (for nasal Nyxoid®) and https://naloxone.uk (for Naloxone 1.26mg Nasal Spray).
See also:
The London Safeguarding Children Partnership (LSCP) delivering free safeguarding training programme to the London public and voluntary sectors:
Adultification Training Session delivered by LSCP:
The LSCP are pleased to offer four Adultification training sessions free of charge to the voluntary and public sector within London.
Adultification forms a key part of the Waltham Forest Safeguarding Children Board’s priority Safeguarding Children Outside the Home so this training would be invaluable to those working with children and young people. There are limited spaces available and the sessions will run on the following dates:
- Monday 9 October 2023, 9.30am to 12.30pm
- Thursday 23 November 2023, 9.30am to 12.30pm
- Thursday 2 February 2024, 9.30am to 12.30pm
- Friday 5 March 2024, 9.30am to 12.30pm
Email Strategicpartnerships@walthamforest.gov.uk to register for these free sessions.
Book home fire safety visit for vulnerable residents
London Fire Brigade triage referrals 24 hours a day and categorise them from very high risk category, which receive a four-hour response, and high risk category referrals receiving a four-day response.
Please call 24/7 phone number to refer residents in need of a home fire safety visit: 0800 028 4428.
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This newsletter is brought to you by the Strategic Partnership Boards, which is made up of Waltham Forest Safeguarding Children’s Board, Safeguarding Adults Board, Health & Wellbeing Board and SafetyNet (our Community Safety Partnership).
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